Provider Demographics
NPI:1174905590
Name:ORTIZ HERNANDEZ, LIMAIRA
Entity type:Individual
Prefix:
First Name:LIMAIRA
Middle Name:
Last Name:ORTIZ HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 168
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00954
Mailing Address - Country:US
Mailing Address - Phone:787-415-2697
Mailing Address - Fax:
Practice Address - Street 1:AVE DOMINICO LEVITVILLE
Practice Address - Street 2:SHOPPING CENTER
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-784-0270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9286183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician